In congenital 3rd degree AV block, treatment depends on whether or not the patient has structural cardiac abnormalities. If the echocardiogram demonstrates structural abnormalities of the heart, treatment includes placement of a permanent pacemaker. If there are no structural abnormalities and the patient is asymptomatic, pacemaker placement can be delayed.

In this patient, he remembered being told as a child that he had “some kind of block in his heart”. He in fact had congenital 3rd degree AV block. His echo was normal. So, placement of a pacemaker was delayed. Ultimately most of these patients become symptomatic at some point in their life and they then require pacemaker placement.